Personal Health Practices Research Articles

Hospital Nursing Staff Perceptions of Resources Provided by Their Organizations During the COVID-19 Pandemic.

Background:The coronavirus disease 2019 (COVID-19) pandemic has profoundly impacted the health and psychological well-being of hospital nursing staff. While additional support is needed to better cope with increased job stressors, little is known about what types of hospital resources have been provided and how nursing staff perceive them. This study addressed this gap by describing nursing staff perceptions of resources provided by hospitals during the COVID-19 pandemic in the United States.Methods:Registered nurses and nursing assistants who were working in hospitals during the pandemic were recruited to an online survey via social media posts and emails between May and June 2020. A total of 360 free-text responses to an open-ended survey question were analyzed using content analysis.Results:Over half of participants reported being provided with hospital resources. “Basic needs” resources that included food on-site, groceries, and childcare support were the most frequently reported compared with four other types of resources (personal health and safe practice, financial support, managerial support, communication). Four themes emerged related to staff perceptions of support: community support, unequal benefits, decreasing resources, and insufficient personal protective equipment.Conclusion:Our findings can assist organizational leaders in the planning and allocation of different types of resources that are meaningful to nursing staff and thus ensure sustainability, optimal performance, and worker well-being during crises.

Assessment of community psycho-behavioral responses during the outbreak of novel coronavirus (2019-nCoV): a cross-sectional study.

The novel coronavirus 2019 (2019-nCoV) is a public health emergency of international concern resulting in adverse psychological impacts during the epidemic.MethodsFrom 1 to 10 April 2020, we conducted an online survey. The online survey collected information on demographic data, precautionary measures against (2019-nCoV), self-health evaluation, knowledge, and concerns about (2019-nCoV), and appraisal of crisis management. The psychological impact was assessed by the General Anxiety Disorder 7-item (GAD-7) scale. The designed questionnaire was answered by participants, and collected data were statistically analyzed.ResultsThis study included 1200 respondents. In total, 80% of respondents rated the psychological impact; 18% reported minimal anxiety; 34% reported mild anxiety, and 48% with moderate anxiety symptoms. A large proportion (74%) believed that they were very or somewhat likely to contract (2019-nCoV) while only (35%) believed they were unlikely to survive if they contracted the disease. (58%) of the respondents, practiced the precautionary measures directed against person-to-person droplet spread. Respondents with a moderate level of anxiety were most likely to take comprehensive precautionary measures against the infection. Also, older, female, more educated people as well as those who are more likely to contract the infection.ConclusionsDuring the outbreak, more than half of the respondents rated the psychological impact as moderate anxiety. Thus, the psychological needs during the outbreak should be addressed appropriately. Our results highlight the need to promote protective personal health practices to interrupt the transmission of the (2019-nCoV) in the community. Therefore, educational public programs about preventive measures should be targeted at the identified groups with low current uptake of precautions.

A comprehensive approach to health promotion for the reduction of dental caries in remote Indigenous Australian children: A clustered randomised controlled trial

To evaluate the effect of a community-oriented primary health care (CPHC) intervention on oral health behaviours of Indigenous preschool children living in remote communities of Australia's Northern Territory. The study was a community-clustered randomised controlled trial over two years, set in 30 remote Indigenous communities in the Northern Territory of Australia. Children aged 18-47 months at baseline were enrolled in the study. The intervention included fluoride varnish applications, training of primary care workers, and health promotion for oral health at an individual, family and community level. Intervention communities received six-monthly visits over two years and control communities were visited at baseline and two years later with no contact in the intervening period. The outcome measures reported in this paper are the impact of the intervention on two secondary endpoints: oral health promotion activities in the community and personal oral health practice of children. The intervention did not produce any significant change in oral health behaviours, clinical measures of oral hygiene, or community programmes promoting oral health. Dental caries can be reduced but will continue to be a problem among young remote Indigenous children while they experience major social disadvantage.

An innovative program to promote health promotion, quality of life, and wellness for School of Nursing faculty, staff, and students: Facilitators, barriers, and opportunities for broad system-level and cultural change

Members of the nursing profession are often challenged by attempts to engage in personal health and well-being practices because of their dedication, commitment, and passion for improving the lives of others through engagement in practice, research, service, and education. Research reveals disproportionately high rates of emotional distress and depression among nurses ( Letvak et al., 2012 Letvak S. Ruhm C. McCoy T. Depression in hospital-employed nurses. Clinical Nurse Specialist. 2012; 26: 177-182https://doi.org/10.1097/NUR.0b013e3182503ef0 Crossref PubMed Scopus (133) Google Scholar ), coupled with challenges relative to work environment and culture as well as with prioritizing self-care. Distress and burnout among nurses are associated with compassion fatigue, poor sleep, trouble concentrating, limited performance in mental or interpersonal tasks, time management challenges, work-place bullying, lower productivity, chronic absenteeism, increased turnover, and compromised quality of care provision ( Drury et al., 2014 Drury V. Craigie M. Francis K. Aoun S. Hegney D.G. Compassion satisfaction, compassion fatigue, anxiety, depression and stress in registered nurses in Australia: Phase 2 results. Journal of Nursing Management (John Wiley & Sons, Inc.). 2014; 22: 519-531https://doi-org.libproxy.lib.unc.edu/10.1111/jonm.12168 Crossref PubMed Scopus (88) Google Scholar ; Ekici and Beder, 2014 Ekici D. Beder A. The effects of workplace bullying on physicians and nurses. Australian Journal of Advanced Nursing. 2014; 31 (Retrieved October 16, 2020 from): 24-33https://www.ajan.com.au/archive/Vol31/Issue4/3Ekici.pdf Google Scholar ; Kelly, 2020 Kelly L. Burnout, compassion fatigue, and secondary trauma in nurses: Recognizing the occupational phenomenon and personal consequences of caregiving. Critical Care Nursing Quarterly. 2020; 43: 73-80https://doi-org.libproxy.lib.unc.edu/10.1097/CNQ.0000000000000293 Crossref PubMed Scopus (25) Google Scholar ; Roelen et al., 2014 Roelen C. van Rhenen W. Schaufeli W. van der Klink J. Magerøy N. Moen B. Bjorvatn B. Pallesen S. Mental and physical health-related functioning mediates between psychological job demands and sickness absence among nurses. Journal of Advanced Nursing (John Wiley & Sons, Inc.). 2014; 70: 1780-1792https://doi-org.libproxy.lib.unc.edu/10.1111/jan.12335 PubMed Google Scholar ). Focusing on the well-being of nurses is a quality and safety imperative to improve the lives of nurses and for the people they serve. Accordingly, the authors of the Quadruple Aim posit that to promote optimal patient outcomes, cost-effective care, and patient satisfaction, we must also prioritize the well-being of providers ( Bodenheimer and Sinsky, 2014 Bodenheimer T. Sinsky C. From triple to quadruple aim: Care of the patient requires care of the provider. Annals of Family Medicine. 2014; 12: 573-576https://doi.org/10.1370/afm.1713 Crossref PubMed Scopus (1543) Google Scholar ).

PMU78 INVESTIGATING DIFFERENCES IN HEALTHCARE EXPENDITURES BETWEEN OPIOID USERS AND NON-USERS AMONG A NATIONAL SAMPLE OF OLDER ADULTS WITH HYPERCHOLESTEROLEMIA AND PAIN IN THE UNITED STATES

To compare the healthcare expenditures of older US adults (≥50 years) with comorbid hypercholesterolemia and pain who use opioid medications and those who do not. This study utilized a retrospective, cross-sectional database design of 2017 Medical Expenditure Panel Survey (MEPS) data. Eligible subjects were those alive for the full calendar year, aged ≥50 years, had a diagnosis of hypercholesterolemia, and reported having pain in the past four weeks. Hierarchical linear regression models were developed to investigate differences in healthcare expenditures (inpatient, outpatient, office-based, emergency room, prescription medications, other, and total costs) between opioid users and non-users. Covariates included predisposing, enabling, need, personal health practices, and external environmental factors. National estimates were obtained by adjusting for the complex MEPS design. An alpha level of 0.05 was set a priori. The study included 2,796 eligible subjects (59.7% aged ≥65 years, 53.5% female, 81.9% white), providing a national estimate of 28,483,745 non-institutionalized older adults with hypercholesterolemia and pain in the US in 2017. Of these, 795 subjects (weighted national estimate 8,079,019 [28.4%]) were categorized as opioid users. After adjusting for predisposing, enabling, need, personal health practices, and external environmental factors, opioid users had 36% greater inpatient expenditure (β=0.310, p=0.0010), 41% greater outpatient expenditure (β=0.341, p<0.0001), 53% greater office-based expenditure (β=0.426, p<0.0001), 62% greater prescription medication expenditure (β=0.483, p<0.0001), 32% greater other healthcare expenditure (β=0.278, p=0.0023), and 79% greater total healthcare expenditure (β=0.581, p<0.0001) versus non-users. However, compared to non-users, opioid users had 8% lower adjusted emergency room expenditures (β=-0.078, p=0.0007). Adjusted healthcare expenditures were greater among opioid users compared to non-users with hypercholesterolemia and pain for all expenditure categories except emergency room expenditures, which were lower. Further research is warranted to investigate these expenditures in greater depth, over longer time periods, and additional populations.

PMS67 DIFFERENCES IN HEALTHCARE EXPENDITURE BETWEEN OPIOID AND NON-OPIOID USERS AMONG A NATIONAL SAMPLE OF COMMUNITY-BASED OLDER UNITED STATES ADULTS WITH PAIN, 2015

Increasing numbers of older adults using opioids presents healthcare challenges in the United States (US). This study compared healthcare expenditures between older US adults (≥50 years) with pain who use opioid medications and those who do not. This study employed a retrospective, cross-sectional database design using 2015 Medical Expenditure Panel Survey (MEPS) data. Eligible participants were alive for the calendar year, aged 50 years or older, and reported having pain in the past four weeks. The key independent variable was opioid use status (opioid users defined using Multum Lexicon therapeutic class codes “60” or “191”). Hierarchical linear regression models were constructed to assess healthcare expenditures (inpatient, outpatient, office-based, emergency room, prescription medications, other, and total costs) between opioid users and non-opioid users, adjusting for appropriate covariates. National estimates were obtained by adjusting for the complex MEPS design. The study cohort consisted of 4,759 subjects (opioid users n=1,525, non-opioid users n=3,234), providing a national estimate of 50,898,592 non-institutionalized older adults with pain in the US in 2015 (opioid users n=16,757,516 [32.9%], non-opioid users n=34,141,076 [67.1%]). In univariate analysis, opioid use was associated with all personal characteristics (p<0.05), except gender and race. After adjusting for predisposing, enabling, need, personal health practices, and external environmental factors, opioid users had 61% greater outpatient expenditure (β=0.477, p<0.0001), 69% greater office-based expenditure (β=0.524, p<0.0001), 14% greater emergency room expenditure (β=0.131, p=0.0045), 63% greater prescription medication expenditure (β=0.486, p<0.0001), 29% greater other healthcare expenditure (β=0.251, p=0.0002), and 105% greater total healthcare expenditure (β=0.718, p<0.0001) than non-users. There was no difference in inpatient expenditures (p>0.05) between opioid users and non-users. Adjusted healthcare expenditures were greater among opioid users compared to non-users for all expenditure categories, except inpatient expenditures. Future research should investigate these variables in greater depth, over longer time periods, and additional populations.

PMU63 EXPLORING THE SYMPTOMATOLOGY OF DEPRESSION AND ITS EFFECT ON HEALTHCARE EXPENDITURES AND QUALITY OF LIFE OF DIABETIC PATIENTS

Depressive symptoms can affect a person's well-being and their ability to self-manage their health condition. The co-existence of depression and diabetes can lead to higher healthcare expenditures and poor health-related quality of life. In this study, we investigated the impact of varying depression symptomatology on total healthcare expenditures and the quality of life of diabetic patients. The 2016 Medical Expenditure Panel Survey (MEPS) data were used to investigate the healthcare expenditures among diabetic adults (aged ≥18 years). A linear regression model was used to elucidate the impact of depression on log-transformed healthcare expenditures. The diabetic patients were stratified into four categories: 1) Diabetes and symptomatic depression 2) Diabetes and asymptomatic depression 3) Diabetes and unrecognized depression 4) Diabetes only, identified using ICD-10-CM code of depression (ICD10= ‘F32’) and patient responses to the PHQ-2 questionnaire. Other independent variables included were predisposing, enabling, need, healthcare environment and personal health practice factors, which influence the healthcare expenditures. Descriptive statistics were used to describe the sample characteristics. Of the 2357 adults with diabetes, 8.32% (n=196) had unrecognized depression, 11.50% (n=271) had asymptomatic depression, and 6.02% (n=142) had symptomatic depression. Diabetic patients with asymptomatic depression had a 90% increase, whereas patients with unrecognized depression had a 14.7% decrease in healthcare expenditures in comparison to the diabetes only group. The mean MCS and PCS scores were significantly higher in the group with asymptomatic depression (MCS=46.79±9.5, PCS=39.47±11.77) and lower in individuals with unrecognized depression (MCS=37.13±11.05, PCS=33.20±11.59). Lower expenditures and MCS/PCS scores in the unrecognized depressed patients may reflect the lack of access to mental healthcare services for clinical diagnosis and treatments. Additional efforts should be explored to identify unrecognized depression in diabetic patients which may minimize the associated burden.

Information Needs of Women Regarding Health and Hygiene Practices

Information is a source of power and is important for individual growth and survival. Information about health and hygiene is crucial because it influences an individual’s quality of life. As far as health and hygiene practices are concerned, women play an active role in getting information about these; hence there is a need to study their information needs regarding health and hygiene. After finding out the needs of women regarding these aspects, accordingly information can be made accessible to them. Keeping this into account, the present study was conducted in Ludhiana district of Punjab. Data was taken from 200 rural and urban women of 25-50 years, by the help of an interview schedule. Health and hygiene practices were studied under three categories as personal, food related and household health and hygiene practices. Information needs were studied on a three point continuum i.e. highly needed, somewhat needed and not needed. Results of the study showed that under personal health and hygiene practice, information on hair care and obesity was most needed. The most needed information regarding food related health and hygiene was on low cost nutritious recipes. The major information need reported by the respondents was related to control of insects and pests in case of household health and hygiene practices and majority of the respondents had low level of information need for all health and hygiene practices. Information needs of the women were positively related with their education and mass media exposure, whereas age was negatively correlated with the information needs of women. Consequently, there is a need to educate women regarding health and hygiene practices through effective communication methods, so that they can realize the importance and need for information on these topics.

Pharmacy students’ personal health practices and perceptions on lifestyle medicine

ABSTRACT Pharmacists are accessible and positioned to facilitate health behavior change among patients with chronic diseases. The readiness of pharmacy students to practice lifestyle medicine is unclear. Doctor of Pharmacy students were surveyed on personal characteristics, health behaviors, and opinions on lifestyle counselling in September 2016. Ninety-three out of 359 (26%) students participated. A greater percentage of students with body mass index less than 25 kg/m2 responded that substance abuse counselling was highly relevant to their intended practices as compared to students classified as overweight or obese (p <.05). Over two-thirds of students without health care-related work experience indicated that weight management (p < .05) and alcohol abuse counselling (p < .05) were highly relevant to their intended practices. Student-specific factors are associated with perceptions on whether particular lifestyle medicine topics are relevant to their intended practices. Pharmacy programs can use study results to identify curricular areas where lifestyle medicine should be further emphasized.

Determinants of Complementary Medicine Service Utilization in a Regional South Australian Population: A Cross‐Sectional Study

The dearth of accessible and appropriate conventional health care services in regional areas may drive many people to seek care provided by complementary medicine (CM) practitioners. Understanding the drivers of CM service use in this population may help inform future health services planning. This study set out to examine the determinants of CM service utilization in a regional South Australian population. Adults residing in regional South Australia between April 2017 and March 2018 were invited to complete the 44-item consumer utilization, expectations, and experiences of health care instrument. The questionnaire was available in print and online, and was promoted using a multimodal recruitment campaign. Independent predictors of CM service use were determined using multivariate logistic regression. Completing the questionnaire were 3,926 adults (56.7% aged 50+ years; 52.5% females). Forty-seven percent of participants reported using a CM service within the last 12 months. Univariate analyses revealed a statistically significant association between 13 factors and CM service use. When these factors were forced into a multivariate logistic regression model, the number of predictors of CM service utilization was reduced to 10, which included 6 predisposing factors, 3 enabling factors, and 1 personal health practice. This model was able to explain 23.1% (Nagelkerke R2 = 0.231) of the variation in CM service use in this sample. A high level of CM service use was reported among participants living in regional South Australia. The findings highlight the degree to which the appropriateness of health services impacts health-seeking behavior in regional communities.

The role of psychosocial factors and treatment need in dental service use and oral health among adults in Norway.

This study aimed to explore whether population characteristics were associated with the use of dental services, individual's personal oral health practices, dental caries and oral health-related impacts using the revised Andersen's behavioural model as the theoretical framework. This cross-sectional study included participants from a Norwegian general population (N=1840; 20-79years) included in the Tromstannen-Oral Health in Northern Norway (TOHNN) study. The variables included in the model were social structure (income, education, urbanization), sense of coherence (SOC), enabling resources (difficulties accessing the dentist, declined treatment, dental anxiety), treatment need, use of dental services, toothbrushing frequency, sugary soda drink consumption, decayed teeth and oral health-related impacts (OHIP-14). Structural equation modelling was used to test the direct and indirect effects within Andersen's behavioural model of access and health outcomes. Andersen's behavioural model fit the data well and explained a large part of the variance in use of dental services (58%), oral health-related impacts (48%) and, to a lesser extent, decayed teeth (12%). More social structures and a stronger SOC was associated with more enabling resources, which in turn, was associated with more use of dental services. Social structures were not directly associated with use of dental services or decayed teeth but were predictive of oral health-related impacts. A stronger SOC was associated with more frequent toothbrushing, less soda drink consumptions, fewer decayed teeth and less oral health-related impacts. Self-perceived need did not predict dental attendance but was associated with decayed teeth. A less frequent use of dental services, less frequent toothbrushing and more frequent sugary soda drink consumption were associated with more decayed teeth. Decayed teeth were not associated with oral health-related impacts. The findings suggests that, in addition to focusing on reducing socioeconomic inequalities in relation to oral health in the Norwegian population, it is also important to consider how people perceive their own resources (eg financial, psychological, social) as well as their access to dental care in order to support regular dental attendance and potentially, in turn, enhance oral health.

Personal Health Practices and Perceptions of Lifestyle Counseling and Preventive Services Among Residents.

Background. Primary care residents are expected to provide lifestyle counseling and preventive services for patients with chronic diseases; also, physicians' personal lifestyle practice impacts patient care. The purpose of this article is to assess healthy lifestyle behaviors and attitudes to engage in lifestyle counseling and preventive services among residents and fellows in different training levels and specialty. Methods. A cross-sectional pilot study was conducted on medical residents and fellows (n = 57). Surveys collected information on lifestyle behaviors and perceptions of lifestyle counseling and preventive services. Comparisons of study measures were made across residents' specialty and training levels. Fisher's exact and analysis of variance tests were used for statistical analysis. Results. There were several significant differences in perceptions of counseling and screening by specialty and training level. There were no significant differences in personal lifestyle behaviors between all resident specialties and training levels. Conclusion. Our findings suggest that there are opportunities to improve healthy lifestyle behaviors and perceptions of lifestyle counseling and preventive services among residents in different specialties and training levels. This knowledge can inform development of training programs in lifestyle and preventive medicine practice during residency and fellowship.

Gender Differences in the Prevalence of Complementary and Alternative Medicine Utilization among Adults with Arthritis in the United States.

Objective To examine the association between sex and the use of complementary and alternative medicine (CAM) among adults with arthritis. Methods Data from the 2012 National Health Interview Survey on CAM use for adults with arthritis were analyzed. Five different multivariable regression models were used to examine the association between sex and CAM use after adjusting for demographics, socioeconomics, perceived health status, functional limitations, comorbid chronic conditions, body mass index, and personal health practices. Results The number of subjects who met the eligibility criteria and were eventually included in the study was 7,919 adults with arthritis. Around half of the study sample reported ever using CAM (n = 4,055), and about 27% (n = 2,016) reported using CAM in the past 12 months. Women have a significantly higher rate of ever utilization of CAM compared to their male counterparts (62.2% vs. 37.8%) as well as CAM use over the past 12 months (66.1% vs. 33.9%). After controlling for other covariates that can potentially affect the use of CAM, women had higher odds of ever using CAM (AOR = 1.68, 95% CI = 1.55–1.81) as well as the CAM use in the past 12 months (AOR = 1.63, 95% CI = 1.49–1.78) compared to men. Functional limitation and multiple comorbidities were associated with CAM use among women. Conclusions The utilization rate of CAM among women with arthritis is significantly higher compared to their male counterparts, which highlights the need to screen adults with arthritis, particularly women, for potential drug-CAM interactions. Also, practicing patient-centered care is important, which should allow the patients to discuss the potential benefits and risks of CAM use with their healthcare providers.

The use of an interdental brush mitigates periodontal health inequalities: the Korean National Health and nutrition examination survey (KNHANES)

BackgroundThe purpose of this study was to evaluate the mitigating effect of the use of interdental brushes on periodontal health inequality.MethodsThis study was based on the data acquired in the Sixth Korea National Health and Nutrition Examination Survey (KNHANES VI; 2013–2015). A total of 17,583 participants (7,633 males and 9,950 females)) aged 19 years or older completed the KNHANES VI between 2013 and 2015. Multivariable logistic regression analysis was performed using socioeconomic characteristics (sex, age, level of education, individual income), personal health practice (smoking, toothbrushing, dental flossing, interdental brushing, dental clinic visiting), systematic medical factors (diabetes mellitus, hypercholesterolemia, hypertension, obesity) and the community periodontal index. We confirmed differences in the prevalence of periodontal disease with the use of an interdental brushes stratified according to individual income.ResultsThree logistic regression models adjusted for covariates hierarchically. In all models, individuals who used an interdental brush were not significantly different from individuals who did not use an interdental brush. The adjusted odds ratio (OR) for interdental brushing was 0.918 with a 95% confidence intervals (CIs) of 0.797–1.057. When periodontal disease was the outcome of the model, the lowest income group had 1.266 (95% CIs 1.066 to 1.502) times the odds of having periodontal disease than the highest income group. In interdental brush nonusers, the lowest income group had 1.276 (95% CI 1.061–1.533) times the odds of having periodontal diseases than the highest income group. However, in the interdental brush users, there were no significant differences in periodontal disease prevalence among income groups.ConclusionsThe results suggest that the use of interdental brushes could alleviate periodontal health inequality.

Physicians’ personal health practices and their effect on their patients‘ health practices.

Background: Although much has been written about the potential power of the association between physicians’ personal health practices and those of their patients, we found few objective studies of this relationship. We therefore investigated this association using objectively measured health care indicators. Aim of the study: The aim of the study was to show the association between physicians’ own screening/immunization practices and their patients screening/immunization practices. Material and methods: We assessed 8 indicators of quality of health care (screening and vaccination practices) for primary care physicians (n=1488) and their adult patients (n = 1 886 791) in Israel’s largest health maintenance organization. The physicians were also patients in this health care system Results: For all 8 indicators, patients whose physicians were compliant with the preventive practices were more likely (p &lt; 0.05) to also have undergone these preventive measures than patients with noncompliant physicians. We also found that more similar preventive practices showed somewhat stronger relations. For example, among patients whose physician had received the influenza vaccine, 49.1% of eligible patients received influenza vaccines compared to 43.2% of patients whose physicians did not receive the vaccine (5.9% absolute difference, 13.7% relative difference). This is twice the relative difference (7.2%) shown for pneumococcal vaccine—eligible patients of influenza-vaccinated versus non vaccinated physicians (60.9 vs 56.8%).When we examined the rates of un-related practices, we found that, for example,mammography rates were identical for patients whose physicians did and did not receive the influenza vaccine Conclusions: We found a consistent, positive relation between physicians’ and patients’preventive health practices. Objectively establishing this healthy doctor—healthy patient relationship should encourage preventionoriented health care systems to better support and evaluate the effects on patients of improving the physical health of medical students and physicians.

Non-traditional melanoma prevention strategies in the young adult and adolescent population.

Non-traditional melanoma prevention strategies in the young adult and adolescent population.

Understanding Fall-Risk Factors for Inuvialuit Elders in Inuvik, Northwest Territories, Canada

Older Indigenous adults in Canada experience disproportionately poorer health outcomes than older non-Indigenous adults. Current fall-prevention literature suggests that older Indigenous adults have higher rates of falls and fall-related injuries; however, no information exists on older Inuit adults’ experience with falls. Using the social determinants of Inuit health (SDoIH) as a conceptual framework, this research sought to understand which of the SDoIH are believed by stakeholders (i.e., local fall prevention programmers [LFPPs] and Inuvialuit Elders) to affect most the likelihood of older Inuvialuit adults’ falls. The findings from the 12 semi-structured interviews and participant observations show that factors related to personal health status and conditions, personal health practices and coping skills, physical environments, social support networks, and access to health services increase older Inuvialuit adults’ likelihood of experiencing a fall. Some determinants, however, decrease their likelihood of experiencing falls (health practices, coping skills, and access to health services), and others, such as culture, were perceived as having little influence on falls. Specific cultural practices were identified as factors that influence the likelihood of older Inuvialuit adults experiencing a fall; however, the overall Inuvialuit culture was not. In light of these findings, we offer recommendations for LFPPs in Inuvik to implement fall-prevention programs that adequately address the SDoIH influencing older Inuvialuit adults’ fall risk and rates.

Impact of a home-based nutrition and exercise intervention in improving functional capacity associated with falls among rural seniors in Canada

Purpose A six-month randomized controlled trial was conducted to examine the impact of a home-based nutrition and exercise intervention on functional capacity to prevent falls among rural seniors. The paper aims to discuss this issue. Design/methodology/approach Men and women (n=134), aged 60 and older were assigned to one of four groups: exercise, nutrition, exercise-nutrition, and control. Participants in the exercise and exercise-nutrition groups performed a home-based exercise program (Home Support Exercise Program), and the nutrition and exercise-nutrition groups received a liquid nutritional supplement (Ensure®) for six months. Participants were assessed at baseline and six months on functional mobility, balance, flexibility and endurance. Findings There were significant group differences over time for functional reach and the Timed Up and Go test, with significant differences existing between exercise and nutrition-exercise, and exercise and nutrition groups respectively. Overall, the exercise group out-performed the other groups in terms of functional capacity and psychological well-being. Research implications Improvement of functional health among rural seniors is achievable through the delivery of a home-based intervention focusing on exercise and nutrition. Practical implications The study also shows that the effective delivery of an intervention to successfully address a fundamental and persistent problem is possible using existing resources; however, it requires a commitment of focus and energy over considerable time. Social implications The approach and findings helps seniors to age in place in a rural context. It shows feasibility of delivering a practical intervention in the rural setting through the health care infrastructure of home care. Originality/value Apart from the rural context, the study was innovative at many levels. Specifically, this intervention addressed a significant health issue (functional capacity, falls and injuries), involved frail rural seniors (often hard to reach through community-based programs), provided a feasible intervention (multiple component exercise program), used existing infrastructure (e.g. home care), and espoused community development principles (active involvement of community partners, researchers, and trainees). As well, the study had built-in mechanisms for monitoring and support through the involvement of home service workers who received training. This approach created a strong research to practice connection (another innovation) and was critical for the credibility of the investigation, as well as the sustainability of the intervention. Another innovation was the inclusion of a population health perspective as the study framework. From the population health perspective, this research addressed several determinants of health in rural and urban areas that include: physical environment (intervention within people’s home and rural context), social environment and social support networks (through existing infrastructures of home support workers), health services (availability of health promotion strategy delivered through the health care system) and personal health practices and coping skills (exercise).

Teachers' Perceived and Desired Roles in Nutrition Education.

Elementary teachers have the potential to influence children's eating habits. This study examined teacher views and practices regarding nutrition education. An online survey was administered to K-6 teachers (N = 628) in 55 public elementary schools in a large city in the western United States. Three indices were created based on responses. Indices included: (1) attitudes and beliefs about nutrition education; (2) self-efficacy regarding nutrition education; and (3) personal health behaviors. Relationships between indices, classroom practices, and teacher characteristics were tested. Teacher comments were categorized into themes. Most teachers agreed they can make a difference in the eating behaviors of their students (68%). Correlations between hours of nutrition taught and teachers' attitudes and beliefs (r = .37, p < .01), nutrition self-efficacy (r = .38, p < .01), and personal health practices (r = .15, p < .01) were weak, yet statistically significant. Number of years teaching was inversely related to frequency of food rewards (r = -119, p < .01). Few teachers (21%) agreed they have support to teach nutrition in the classroom. Teachers understand the importance of nutrition education but provision is limited by competing demands. Teachers suggest tailored nutrition materials, qualified nutrition personnel, and school stakeholder support to promote nutrition education.

Anticipated Engagement in a Village Organization for Aging in Place

Although older adults prefer maintaining residence independently in the community as they grow older it is not always possible due to impairments, isolation, and changing health needs. Villages, an emerging consumer-directed care model providing social engagement and services, support aging in place. To be viable organizations villages must attract and enroll sufficient numbers of members. This study examined factors associated with older adults anticipated engagement as a village member. Using a cross-sectional survey design community residing older adults (N = 193) identified predisposing, enabling, and need factors associated with anticipated engagement. Participants rated anticipated engagement between “Slightly Unlikely” and “Likely” (Mean = 2.71, SD = 1.31). A model including predisposing and enabling factors produced the best overall fit [−2 Log likelihood = 246.514, χ2(8) = 20.414, p. = .008] correctly classifying 61.1% of cases and explaining 13.4% of the variance according to the Nagelkerke R2 statistic. Older adults who engage in preventative health behaviors may be predisposed to joining a village as well as those who are already engaging in supportive acts of neighboring. Villages might consider these factors in designing outreach and service programing. Future research should identify how factors such as income and personal health practices contribute to interest in village membership.